Provider Demographics
NPI:1316516586
Name:SPECTRUM BEHAVIORAL SERVICES
Entity type:Organization
Organization Name:SPECTRUM BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:601-407-9286
Mailing Address - Street 1:215 WOODLINE DR STE A
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9721
Mailing Address - Country:US
Mailing Address - Phone:601-407-9286
Mailing Address - Fax:
Practice Address - Street 1:215 WOODLINE DR STE A
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9721
Practice Address - Country:US
Practice Address - Phone:601-407-9286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center